“Many theories have been postulated about its origin but, the most widely accepted theory is the back flow of menstrual blood through the fallopian tubes and finding its way into the pelvis,” explains Dr Partha Sarathi Das, Specialist Obstetrician and Gynaecologist, Zulekha Hospital, Sharjah.

The menstrual blood gradually over the years engages in a symbiotic relationship with the pelvic tissues resulting in the formation of ‘chocolate’ cysts, adhesions with the fallopian tubes, uterus, bowel and urinary bladder. Usually the patient faces infertility or severe pelvic pain during menstruation or intercourse.

If you are infertile and the diagnosis of chocolate cyst is confirmed by ultrasound, then the way forward is to get a laparoscopy done. Laparoscope inserted through the anterior abdominal wall with a small incision visualizes the abdominal and pelvic organs in a magnified manner. The anatomy of the ovary with the ovarian cyst and its relationship with the fallopian tubes, uterus and the bowel is then assessed. The endometriotic cyst wall is then cauterized and removed and the ovary is then reconstructed back.

Adhesions between the fallopian tubes, uterus and the bowels if any are released. After three months of surgery, fertility treatment options should be considered.

As is well known that pregnancy is the best cure for endometriosis, aim is to offer fertility options depending on the pelvic pathology. If fallopian tubes are blocked, then one should opt for artificial reproductive techniques.

The moral of the story is pro-activeness and completing your family as soon as possible.

If one does not desire any more children, then the best way forward is laparoscopic removal of the cyst with ovarian reconstruction and or followed by birth control pills or progesterone pills continuously or cyclically.

During the laparoscopic surgery, pre-sacral neurectomy can be done to alleviate pain. This method involves disrupting the nerve fibres responsible for causing pain. For patients who are in the peri-menopausal age group, surgical approach combined with medical management seems to be a good option to buy as much time as possible to keep the endometriosis under control before menopause sets in. Menopause which is a physiological stoppage of ovarian function ultimately can prevent a lot of surgical intervention. -news@khaleejtimes.com